Interstitial nephritis associated with ulcerative colitis in monozygotic twins

Area of Science:

• Nephrology
• Gastroenterology
• Genetics

Background:

• Ulcerative colitis (UC) is an inflammatory bowel disease.
• Renal impairment is a rare complication of UC.
• Interstitial nephritis can be an idiosyncratic reaction to 5-aminosalicylate (5-ASA).

Observation:

• Monozygotic twins were diagnosed with UC separately.
• Both twins were treated with 5-ASA and developed interstitial nephritis.
• They were unaware of their shared diagnosis and treatment.

Findings:

• Concordant adverse drug reactions, specifically renal impairment, occurred in both monozygotic twins during 5-ASA treatment.
• Treatment with granulocyte/monocyte adsorption led to UC remission and improved renal function in both individuals.
• This case suggests potential genetic predisposition to specific drug responses in UC patients.

Implications:

• Drug or treatment responses may be concordant in monozygotic twins with UC.
• Careful patient selection and monitoring are crucial before initiating 5-ASA therapy.
• This case underscores the need for thorough pre-treatment reviews to prevent serious adverse events like drug-induced interstitial nephritis.